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NPI Code Detail

MEDICARE: DR. BANANI DIRGHANGI M.D.

MEDICARE: DR. BANANI DIRGHANGI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician15220TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467446716
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BANANI DIRGHANGI M.D.
Provider Business Mailing Address
First Line : 877 JEFFERSON AVE
Second Line : 5TH FLOOR ADAMS PAVILION
City : MEMPHIS
State : TN
Zip : 38103-2807
Country : US
Telephone Number : 901-515-5500
Fax Number : 901-458-5591
Provider Business Practice Location Address
First Line : 2500 PERES AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38108-1660
Country : US
Telephone Number : 901-515-5500
Fax Number : 901-458-5591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 12/31/2009

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